The ability to express our needs, wants, and feelings directly and honestly and to see the needs of others as equally important is the sine qua non of satisfying and effective relationships. Yet, many people become trapped within communication patterns that prevent self-expression. No doubt, these difficulties with communication have a negative impact on the person's ability to enjoy relationships and accomplish life goals. Difficulties with assertiveness may even represent a core vulnerability for severe psychopathology and contribute to the maintenance of social and occupational impairment. In this way, a clinically validated approach to helping people become more assertive would be extremely valuable. The Assertiveness Workbook integrates principles and strategies developed in an assertiveness training program at the Vancouver Hospital and is aimed at providing step-by-step self-help instruction.

The book comprises 16 chapters in two sections: the first section is titled "Understanding Assertiveness" and includes defining and juxtaposing assertiveness with other less-adaptive styles of communication - the passive, aggressive, and passive-aggressive styles. Paterson outlines the behaviours that characterize each of these styles, such as the avoidance of disagreement (passive), dismissing or ignoring the needs of others (aggressive), or the deliberate forgetting or delaying of a promised task (passive-aggressive). While we often think of assertiveness in terms of behaviours, Paterson presents a broader interpersonal model of assertiveness that highlights the dynamic interplay of beliefs, emotions, and behaviours that shape the context for assertiveness. For instance, beliefs such as "other people are more important than me " are likely to lead to behavioural passivity and feelings of helplessness and are just as important to target for improvement as the assertive behaviours themselves.

Paterson is effective in getting across to the reader the cyclical nature of assertiveness (or its absence) through clinical case vignettes. The first chapter ends with a self-assessment section where readers are asked to record where, when, and with whom they are most likely to engage in passive, aggressive, or passive-aggressive styles of communication, and the perceived benefits if they could become more assertive in these contexts.

After describing the multidimensional aspects of assertiveness, the remaining chapters in this section outline the barriers that may emerge as the person contemplates becoming more assertive. In Chapter 2, Paterson provides a cursory description of the role of stress and its impact on assertiveness, and provides a number of cognitive and behavioural strategies to cope with stress. Chapter 3 gives attention to the importance of gender role socialization in shaping the expectancies of assertiveness and the difficulties that may arise if the person is to become more assertive. Chapters 4 and 5 focus on the importance of underlying beliefs that influence passive, aggressive, and passive-aggressive styles. For instance, the belief that "being assertive means being selfish" may predict a passive role, while the belief "nice guys finish last" may lead to an aggressive style. Following the description of each belief, Paterson provides a disputation of each belief and an alternative outlook to be considered. Chapter 6, titled "On the Launchpad," is aimed at getting the person prepared to do some difficult work with simple reminders of how to practice - "allow errors," "start easy," and "pick a model" to emulate.

The first section of the book is well-written and well-organized and has many positive features that lend itself to be used as a self-help tool. There are frequent checkpoints where the reader is instructed to tick boxes, write lists, or in some other way personalize their reading. Notwithstanding, the real benefits are located in the second section of the book where there are specific, detailed, step-by-strategies for building assertiveness skills.

Across the remaining 10 chapters, specific skill areas are identified and exercises are outlined for practice. For instance, in Chapter 7, the importance of assertive nonverbal behaviours are outlined, including posture, movements, eye contact, voice tone, etc. The reader is instructed to develop a list of problematic nonverbal behaviours. Following the development of the problem list, the reader is asked to select one behaviour at a time and work on it for a week. The exercises here are excellent and start at a level that should be within reach for the average reader - for instance, taking a 30-minute walk while practicing posture or voice training by making phone calls. Other exercises described include the rehearsal of scripted problems, for example, having to complain about a service or requesting a refund for a damaged item. Exercises can be done with a partner or in front of a mirror. Additional chapters include exercises to practice giving one's opinion (Chapter 8) and giving and receiving positive and negative feedback (Chapters 9-11). Steps for building advanced skills to provide corrective feedback to others (Chapter 12) and learning to say "no" to requests (Chapter 13) are the focus of the next two chapters. The final chapters deal explicitly with the management of confrontation. The importance of self-monitoring one's progress and working with the barriers that are encountered during practice is built into each chapter.

In summary, this is an excellent, easy-to-use workbook for those wanting to improve their assertiveness and should be recommended reading for clients and therapists alike. The Assertiveness Workbook does not explicitly adopt a cognitive-behavioural conceptualization although the task-assignments outlined are entirely compatible with a CBT approach and may be a most useful recommendation for clients and therapists working within this modality.

Neil Rector is an Assistant Professor of Psychiatry at the University of Toronto and Head of the Anxiety Disorders Clinic, Centre for Addiction and Mental Health, Clarke Division.